Healthcare Provider Details

I. General information

NPI: 1255256863
Provider Name (Legal Business Name): MAHNOOR AHSAN GHUMMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DAVIS ST
EVANSTON IL
60201-4619
US

IV. Provider business mailing address

9523 LAVERGNE AVE
SKOKIE IL
60077-1354
US

V. Phone/Fax

Practice location:
  • Phone: 847-558-1322
  • Fax:
Mailing address:
  • Phone: 319-486-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.032953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: